Hemodynamic factors for development of septic AKI
What are the hemodynamic factors that play a role in the development of septic acute kidney injury?
• In Sepsis associated acute kidney injury, multiple and overlapping mechanisms lead to acute kidney injury. These include: alterations in systemic and kidney hemodynamics, cellular injury, and immune and inflammatory mediator-induced injury.
• Hemodynamically, sepsis is associated with decreased peripheral vascular resistance, maldistribution of tissue blood flow, and profound abnormalities in the microcirculation.
These abnormalities lead to a heterogeneous distribution of tubular cell injury that can be quite variable in severity.
Mechanistically, several mechanisms contribute to alterations in regional renal blood flow:
(1) increases in renal vascular resistance;
(2) capillary (micro-circulatory) occlusion due to platelet activation, fibrin deposition, and leukocyte aggregation along with endothelial cell swelling;
(3) increases in vascular permeability that within an encapsulated organ, such as the kidney, which lead to interstitial edema, venous congestion, and alterations in transmural pressures;
(4) changes in nitric oxide production; and (5) imbalances between vasodilators and vasoconstrictors resulting in more pronounced vasoconstriction and redistribution of regional blood flow
